Abstract

The "identified lives effect" describes the fact that people demonstrate a stronger inclination to assist persons and groups identified as at high risk of great harm than those who will or already suffer similar harm, but endure unidentified ("statistical lives").

As a result of this effect, we allocate resources reactively rather than proactively, prioritizing treatment over prevention. For example, during the August 2010 gold mine cave-in in Chile, where ten to twenty million dollars was spent by the Chilean government to rescue the 33 miners trapped underground. Rather than address the many, more cost effective mine safety measures that should have been implemented, the Chilean government and international donors concentrated efforts in large-scale missions that concerned only the specific group. Such bias as illustrated through this incident raises practical and ethical questions that extend to almost every aspect of human life and politics.

What can social and cognitive sciences teach us about the origin and triggers of the effect? Philosophically and ethically, is the effect a "bias" to be eliminated or is it morally justified? What implications does the effect have for health care, law, the environment and other practice domains?

This volume brings together a group of leading scholars from psychology, public health, law, ethics, and public policy, to answer these and other questions. This .pdf contains the book's table of contents and an introduction that summarizes the contents of the book and frames three key question the book seeks to answer:

1. When precisely does the identified person effect arise? And what exactly does it consist in? For example, is it simply a matter of a very human response to the vivid human faces of people with personal stories, in the hospital ward or on TV screens? Is it something that arises only when the risks are known, only under strict uncertainty, or regardless of how much we can specify the risk? Does that effect arise only when few victims are involved? (Stalin, it is claimed, memorably said, "The death of one man is a tragedy, the death of millions is a statistic.") And when we are inclined to prioritize identified persons, are we just inclined to help them, or typically also inclined to feel in certain ways (say, compassionately) and to suppress thought about certain things (say, potentially relevant considerations such as cost to others and to society, health and welfare distribution in previous decades, personal desert, and personal responsibility)?

2. What, if anything, might justify giving priority to identified persons at risk? After all, they are not necessarily poorer or sicker over their entire lives than the rest of us, or otherwise necessarily worse off in their personal outcomes. Priority to identified persons does not necessarily assist the deserving, or the near and dear, or whomever else we may think we should prioritize. Ex hypothesi, focus on those at highest risk does not ensure that more lives or QALYs are saved; on the contrary, it often ensures that fewer are saved. Nor is this necessarily the familiar question about "aggregation" (whether preventing tiny harms to scores of people can ever be more urgent than preventing a momentous harm to one). Risk does not always translate into harm. So is our inclination to prioritize identified persons warranted, and (if so) on what ground?

3. What would be the practical implications for law, public health, medicine, and the environment of accepting the priority given to identified persons, or of forsaking it — if we could successfully do so? For example, is it appropriate that in some ways tort law requires an identified victim to bring forth suits? Can our moral position on the effect help us decide how to allocate resources between HIV/AIDS treatment and prevention in the developing world, and evaluate so-called "treatment-as-prevention"?

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